Research into psychedelic substances has grown considerably in recent years, generating enthusiasm among clinicians, investors and the general public. Clinical trials indicate encouraging results for people suffering from mental health disorders such as depression, post-traumatic stress disorder and end-of-life anxiety.
Recently, eating disorders (EDB), a category of serious and difficult to treat pathologies, have received particular attention. One survey found that 70% of people view psychedelic medicine as a promising avenue for EDs, and there are many reports of positive results.
Social media platforms are full of fascinating stories, whether online articles, Netflix documentaries, Reddit threads, TikTok or YouTube videos. But the crucial question remains: does the scientific evidence match this hype?
As a doctoral student in the field of neuropsychiatry, and with a personal interest in EDs, I dove into the literature to evaluate the evidence for psilocybin-assisted therapy in the treatment of these disorders.
Long-term management of TCA
EDs have the highest mortality rate among psychiatric disorders, and their prevalence is increasing. Treatment usually involves a combination of medication and therapy, but avoidance, defection, and resistance are all too common. Many patients go untreated or endure symptoms for the rest of their lives. Overall, we lack treatment options that can provide long-term improvements.
Although the causes of EDs are diverse, patients often exhibit alterations in brain connectivity and serotonin neurotransmission. These changes affect regions involved in body image, mood, appetite and gratification, resulting in “cognitive inflexibility”.
This manifests itself in rigid thought patterns, such as rigorous calorie counting, withheld emotions, and punishing exercise regimes, among other ED-related behaviors. Cognitive inflexibility may also be the cause of treatment resistance.
(Shutterstock)
Underlying mechanisms
It appears that standard treatments do not address all of the mechanisms underlying EDs. Unlike traditional therapist-led treatments, psilocybin therapy uses the psychedelic experience to modify brain activity and promote cognitive flexibility.
Psilocybin, a natural plant alkaloid found in mushrooms of the genus Psilocybe, was first introduced to Western medicine by indigenous communities in the 1950s. It increases serotonin neurotransmission while reducing the activity of brain networks linked to rigid thought patterns. These transformations are believed to improve body image, reward processing and release of beliefs, thereby catalyzing the therapeutic process. But do the clinical data confirm this? To a certain extent.
A case study describes a woman with treatment-resistant anorexia nervosa who, after two doses of psilocybin, experienced immediate improvement in her mood, a better understanding of the origin of her symptoms, and long-term resolution of her symptoms. weight problem.
Another study showed that a single dose of psilocybin was safe and tolerable in women with anorexia nervosa, and that it reduced their concerns about their body image.
-In another report, a person with body dysmorphic disorder responded well to treatment with fluoxetine and psilocybin, despite being resistant to other medications.
Theoretical evidence suggests that psilocybin may play a role in treating hyperphagia, compulsive overeating, and food addiction, while alleviating depressive and traumatic symptoms. However, despite these interesting perspectives, numerous limitations qualify the results.
Research issues
The gold standard for any approach is the randomized controlled trial (RCT), where participants are randomly assigned to an intervention or a control group, ideally without knowing which. The idea is to reduce the impact of individual differences and expectancy bias to truly see whether an intervention is effective or not.
However, for RCTs of psychedelics, it can be difficult to keep participants in the dark, with hallucinations being something of a telltale clue.
Many studies involve small and undiversified sample sizes, which limits the possibilities for real-world application. Although psilocybin has a good margin of safety, participants are very vulnerable during psychedelic experiments. The experience is often indescribable and different for everyone, making the informed consent process ethically difficult.
(Shutterstock)
It is also essential to recognize “overenthusiasm” in this field, where personal use of psychedelics by researchers and participants can introduce bias. Among other limitations, we must be aware of the consequences of this phenomenon on the results presented in the media.
Patient safety
Overemphasizing the therapeutic actions of psilocybin or selectively presenting positive results may cause more harm than good. Due to regulatory restrictions, some patients obtain psilocybin illegally, without proper safety protocols or medical supervision. While this may reflect a failure of the healthcare system, the right mindset and environment are essential for a safe and productive session.
The therapeutic action of psilocybin goes beyond the psychedelic experience; its integration with the help of a therapist is essential to apply its benefits. Accounts suggesting that a single exposure to psilocybin is enough to cure are dangerous.
Finally, we need to consider how the commercial hype surrounding psilocybin could drive up costs, limiting access to those who need it most.
While enthusiasm for psilocybin-assisted therapy is warranted, cautious optimism is essential. We still need to determine the optimal therapeutic framework for EDs, and how it can be offered effectively and ethically to the entire population.
